Resilience

- The Synopsis
Learning Objectives

Define what Resilience is

Explore 3 core components of The Nedrow Resilience Triad

Values

a, Personal
b, Workplace

Self-Care

a, Boundaries
b, Compassion

Insight

a, Self- Awareness
b, Reflection

What is resilience?

Every person’s recipe for resilience is individual.

Resilience is a process. It something to work towards, not a defined permanent

state.

Resilience can be learned and developed, rather than something you’re 'just born
with' or not.

It’s not just about individual effort. It involves supportive relationships. In fact,
what helps us to become more resilient is the support of friends, family and
colleagues both when we receive their help and when we help or engage with them.

The other key component in building resilience is evolving an ability to develop

flexibility and adaptability in our thinking, daily and professional lives.

So how can we try to succinctly define what Resilience is? Consider some of the
following……


The ability of a substance to spring back into shape

OR

Resilience consists of the features of the Resilience Triad by Nedrow et al.

• Self-Care
• Insight
• Values.

OR

Brene Brown’s Five Factors of Resilient People

• They are resourceful and have good problem-solving skills

• They are more likely to seek help
• The hold the belief that they can do something that will help them to
manage their feelings and to cope
• They have social support available to them
• They are connected with others, such as family and friends.

References to start with for the above

Bouncebackproject.org

Brown, Brene. The Gifts of Imperfection: Let Go of Who You Think You’re Supposed
to Be and Embrace Who You Are. 2010. Kindle Version - in particular Signpost 2
and 3 especially

Explore the components of a Resilient life focusing on the following

elements of The Resilience Triad, as per Nedrow et al (2013)


Values

Personal values

Workplace values

Personal values development strategies to consider

Ask yourself and your learners about your personal values

What motivates you at work?

What gives you energy at work?

Do you celebrate your personal successes at work or home?

• Sometimes it’s the simple things

• Keeping a plant alive for more than a week
• Running 5 km early in the morning,
• Remembering your Mums Birthday!
• Getting a positive review by your supervisor
• Getting a compliment from a patient?

What give you a sense of purpose – what’s your Ikigai?

• What do you love about what you do at work?

• What are you good at?

Ikigai

• Japanese for reason for meaning to life or purpose

o Iki - life/alive
o Gai - effect/worth
• To find you work Ikigai is perhaps to find satisfaction, energy and
meaning to your work life.

See the WRaP EM Module on Ikigai/Meaning Making for further information



Picture Reference - https://commons.wikimedia.org/wiki/File:Ikigai-EN-

optimized-PNG.png

Workplace values

Ask yourself

• Do your values as discussed above align with your workplace’s values?

• If so, why?
• If not why, not?

Does my workplace encourage innovation and change?

• If so, why
• If not why, not?

Does your workplace celebrate successes?

• As well as assessing losses/error critical incident?

• A colleague passing an exam
• A good week of patient flow
• Low rates of hospital acquired infections

References to start with for the above

Nedrow, A., Steckler, N. A., & Hardman, J. (2013). Physician resilience and
burnout: Can you make the switch? Family Practice Management, 20(1), 25 30.
https://doi.org/10.1016/S1069-5648(13)60012-X


Self-Care

“In the unlikely event of an emergency, fit your own oxygen mask first, before
attending to children or dependents”

Boundary Creation

Self-Compassion

Boundary creation and work/life integration/balance

One of the biggest challenges faced by anyone working in the 24/7 Health Care
industry.

Both personal and workplace facilitated boundaries are equally important.

Consider the personal contribution to boundary creation in general terms?

• Plan and insist to yourself upon regular breaks/holidays

• Studies show direct correlation between high leave balance and risk of
Burnout

Optimise you shift pattern routine preparation

• Especially sleeping environment optimisation ie air con/black out blinds

in warm climates for day-time sleeping

Plan your time off and try to make it work with shift work

• Can be a challenge
• Morning brunch before evening shifts.

Consider your work life integration

• Full time Versus Part Time

• Dropping to 0.5 - 0.75 FTE around exams
• Or other times of family of personal need.

Develop Contactability Boundaries esp with your work

 • Establish a standard of…
o If you want really want to communicate with me, ring me.
o I may not respond to an email or a text immediately
• Avoiding access to work emails from home
• Avoid going to work on your rostered days off if possible.

Develop more defined Social Media Boundaries

• Consider turning off your data at work or in the evening at home

Create a Mental Gap between work and home

• Efficiency is key.
• Techniques which may help include
• Prolonged mindful hand wash before leaving work
• Square breathing when you sit into your car or the bus home
• Look to Adam Fraser’s research on The Third Space for further
information

Consider the Work Organizational contribution to boundary creation?

• Regular access to leave balance including

• Recreational leave
• Study and exam leave
• Maternity/paternity leave

Optimise shift patterns

• Adequate break post night shift

• Forward cycling only
• Access to non-clinical time
• Protected teaching opportunities

No standard of expectation of paid and especially unpaid overtime

References to start with for the above

Nedrow, A., Steckler, N. A., & Hardman, J. (2013). Physician resilience and
burnout: Can you make the switch? Family Practice Management, 20(1), 25

30. https://doi.org/10.1016/S1069-5648(13)60012-X

Adam Fraser - The Third Space, Transitions and Rituals.

https://www.youtube.com/watch?v=dpk_dssZXqs

Brown, Brene. The Gifts of Imperfection: Let Go of Who You Think You’re Supposed
to Be and Embrace Who You Are. 2010. Kindle Version.

Self-compassion

Self-compassion one of the biggest challenges we face in a developing a resilient

life

Many Health Care workers, whether physicians or nurses, start their careers
with the intent to learn and have an ability to make a difference. This can help
create a compelling and rewarding career.

However, through the subsequent years of shift work, ongoing education and
exams, this sense of service can become more akin to a sense of duty.

The personal sacrifices sometimes required can feel more like deprivation, even
victimisation when self-sacrifice becomes exhausting.

All of our Health Care colleagues are generally committed to ‘excellence’ in their
own practice. They generally also expect this from the teams expect this of them.

There can be a perceived zero tolerance for mistakes. Mistakes can be perceived
to lead to worse patient outcomes. This can breed perfectionism and lack of
acceptance for error.

Doctors and nurses also value compassion - this is a delicate balance of empathy
and control of emotional boundaries with patients but also with colleagues.

And because of all of the above reasons, self-compassion is a real challenge to

those working in Health Care.

So then how can we begin to understand and cultivate self-compassion?

Dr Kirsten Neff suggests that Self Compassion needs 3 elements:

• Self-Kindness
o As opposed to Judgement
• Common Humanity
o As opposed to Isolation
• Mindfulness
o As opposed to autopilot

Self-Kindness

• Use kind and gentle language with oneself when we suffer, fail or feel
inadequate
• Talk to yourself like you would talk to a friend who is suffering
• The opposite of self-kindness is to ignore our pain or flagellate ourselves
with self-criticism
• Self-kindness is NOT passive or ‘lazy’.
• It actually creates a growth mindset

Common Humanity

• Recognising that life is imperfect

• It’s the normal human experience
• Even if that’s really uncomfortable
• Avoiding isolating yourself
• Everyone has gone through a painful experience

Most powerful words to say to your colleagues is ‘I’ve been there’

Mindfulness

• Being aware of suffering but not over identifying with same

• See Modules on Mindfulness for further information

References to start with for the above

Nedrow, A., Steckler, N. A., & Hardman, J. (2013). Physician resilience and

burnout: Can you make the switch? Family Practice Management, 20(1), 25

30. https://doi.org/10.1016/S1069-5648(13)60012-X

Adam Fraser - The Third Space, Transitions and Rituals.

https://www.youtube.com/watch?v=dpk_dssZXqs

Kirsten Neff on Compassion

http://ed.ted.com/on/zhq011AI - digdeeper

http://self-compassion.org/videos/

See other WRaP EM modules including Self Care, Professionalism and

Mindfulness Modules.

Insight

Two important components of insight are self-awareness and reflection

• Self-awareness
• Reflection

Self-Awareness

Only when you know yourself first, can you know your response next

Get to know your

• Stress triggers
• Strengths and Weaknesses
• Your communication styles
• Stress reduction strategies that work for you

This section can be applied to any work setting in your hospital, but is
particularly relevant to those working in busy Critical Care settings.

Know yourself first

Self-awareness doesn’t just happen for most of us. It requires practice.

• Consider scheduling your self-awareness check in

o When you get to work and turn of the car ignition
o When you sit back into the car after work
o When you get a resus ambulance call


What do I ask myself when I do remember?

Perhaps ask yourself 5 short questions - ‘Am I HALTS’?

• Hungry
• Angry
• Late
• Tired
• Stressed

Review your potential distractions

• In particular Social Media and emails

• See above section on personal boundaries

Know your strengths

See above section on Ikigai, within Values section

Now that you know yourself, explore getting to know your response next

“Between stimulus and response there is a space. In that space is our power to
choose our response. In our response lies our growth and our freedom.”

Viktor Frankl

References to start with for the above

Morgenstern, First 10 EM - The definite online summary on Stress Inoculation

Training

https://first10em.com/2017/03/13/performance-under-pressure/

2. Reflection

See WRaP EM Module on Reflective Practice for further information